Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

HIV

Menu
Menu

Quick Links

Veterans Crisis Line Badge
My healthevet badge
EBenefits Badge
 

Integrated Mental Health Care

for Health Care Providers

Integrated Mental Health Care

Overview

Collaboration and communication among the health care team members is central to integrated health care. Integrated health care teams work together to establish treatment plans addressing patients' biological, psychological, and social needs. The interdisciplinary health care team can include many types of providers, such as physicians, psychologists, social workers, and occupational and physical therapists, etc. The team makeup is dependent on the patient's needs.

Addressing the high prevalence of mental health and substance use disorders (MH/SUD) in Veterans with HIV by increasing the availability of services for such disorders is critically important for successful treatment. Mental health providers in particular can add the following services to an integrated care team (adapted from an American Psychological Association fact sheet for policymakers):

  • Cognitive, capacity, diagnostic, and personality assessments that differentiate normal processes from pathologic states, side effects of medications, adjustment reactions, or combinations of these problems
  • Behavioral health assessment and treatment that provide individuals with the self-management skills necessary to effectively manage their chronic conditions
  • Diagnosis and treatment of mental and behavioral health problems (e.g., depression, suicide risk, anxiety disorders, addiction, and insomnia)
  • Consultation and recommendations to family members, significant others, and other health care providers

Ongoing substance use and active psychiatric disorders are common barriers to HIV treatment among Veterans.

Given the high prevalence of MH/SUD in Veterans with HIV, increasing the availability of services to address this need is of critical importance in their successful treatment as research shows that integrated mental health care can increase HIV treatment adherence and improve overall health outcomes.

Integrating mental health services into HIV clinical care settings can take many forms. Ojikutu et al. (2014) have emphasized the following aspects for successful models of integrated HIV care:

  • Patient centered with integrated or co-located services
  • Diverse teams of clinical and nonclinical providers
  • A site culture that promotes a stigma-reducing environment
  • Availability of comprehensive medical, behavioral health, and psychosocial services
  • Effective communication strategies
  • Focus on quality

Bonner et al. (2012) propose three models for treatment of patients with chronic hepatitis C virus (HCV) infection. Although treatment of HCV has evolved, these models can be adapted for current HIV treatment. They encourage clinics to select the model best suited to local resources and expertise. Some of the advantages of each of these models of care are outlined in the following table.

IntegratedCollaborativeHybrid
Co-located services
Convenience for staff
Convenience for patients
Most streamlined and efficient
Maximizes access to MH/SUD services
Strong and ongoing relationship with MH/SUD providers and clinics
Providers use outpatient consultation
Staffed by nonphysician providers with training in MH/SUD care
Brief screening and intervention
Assistance in case management

Across all models of integrated care, a specialty staff is critical for improving treatment outcomes, retention in care, and quality of life for patients. Social work and case management staff are vital to facilitating communication among providers, monitoring treatment outcomes, recognizing concerns that may not present during clinic visits, and connecting Veterans to important resources necessary for continued engagement in care as well as overall health outcomes. Liaison with mental health and substance use staff is also crucial, as primary care is responsible for many patients with comorbid disorders who may not have been diagnosed or treated for MH/SUD. When concerns are identified during clinic visits, access to same day MH/SUD evaluation is optimal.

Integrated care models also utilize Tele-Mental Health services to facilitate access to and delivery of MH/SUD services, especially with regard Veterans who face significant barriers to accessing care. Increased use of telehealth could significantly increase Veterans' access to mental health services by addressing critical barriers to care such as stigma, distance from care providers, and disability.

General Clinician Tools

SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)

American Psychological Association: HIV/AIDS ResourcesLink will take you outside the VA website. VA is not responsible for the content of the linked site.Includes blog posts, fact sheets, podcasts, and other resources

American Academy of HIV Medicine: HIV Specialist Special Issue on HIV and Mental HealthLink will take you outside the VA website. VA is not responsible for the content of the linked site.

Clinician Tools for Addressing Substance Use

Reducing Alcohol Use

Brief Interventions for Alcohol Use DisorderLink will take you to our Viral Hepatitis internet site

Self-Administered Screening for Substance Abuse

Pocket Guide for Alcohol Screening and Brief InterventionPDF icon

Addiction Pharmacotherapy for Alcohol Use Disorders:Link will take you to our HIV/AIDS internet site

Treating PTSD in the Context of Complex Medical Issues

VA's National Center for PTSDLink will take you outside the VA website. VA is not responsible for the content of the linked site.

VA PTSD Consultation Program for Providers inside and outside VA who are treating Veterans; Services are freeLink will take you outside the VA website. VA is not responsible for the content of the linked site.

Health Psychology/Behavioral Medicine

Medication AdherenceLink will take you outside the VA website.

Obesity

Crisis Intervention

Pain ManagementLink will take you outside the VA website. VA is not responsible for the content of the linked site.

Tobacco Cessation

For Patients:

Make the ConnectionLink will take you outside the VA website. VA is not responsible for the content of the linked site.

Journal Articles

Bonner JE, Barritt AS 4th, Fried MW, et al. Time to rethink antiviral treatment for hepatitis c in patientsLink will take you outside the VA website.. Dig Dis Sci. 2012 Jun;57(6):1469-74.

Fix GM, Asch SM, Saifu HN, et al. Delivering PACT-principled care: are specialty care patients being left behind?Link will take you outside the VA website. J Gen Intern Med. 2014 Jul;29 Suppl 2:S695-702.

Hoang T, Goetz MB, Yano EM, et al. The impact of integrated HIV care on patient health outcomesLink will take you outside the VA website.. Med Care. 2009 May;47(5):560-7.

Ojikutu B, Holman J, Kunches L, et al. Interdisciplinary HIV care in a changing healthcare environment in the USALink will take you outside the VA website.. AIDS Care. 2014;26(6):731-5.

Willenbring ML. Integrating care for patients with infectious, psychiatric, and substance use disorders: concepts and approachesLink will take you outside the VA website.. AIDS. 2005 Oct;19 Suppl 3:S227-37.

Zaller N, Gillani FS, Rich JD. A model of integrated primary care for HIV-positive patients with underlying substance use and mental illnessLink will take you outside the VA website.. AIDS Care. 2007 Oct;19(9):1128-33.

External Websites

References

Primary Care of Veterans with HIVLink will take you to our HIV/AIDS internet site

Health Care Reform: Integrated Health Care

Workforce Issues Related to: Physical and Behavioral Healthcare Integration

Bonner JE, Barritt AS 4th, Fried MW, et al. Time to rethink antiviral treatment for hepatitis c in patients with coexisting mental health/substance abuse issuesLink will take you outside the VA website.. Dig Dis Sci. 2012 Jun;57(6):1469-74.

Ojikutu B, Holman J, Kunches L, et al. Interdisciplinary HIV care in a changing healthcare environment in the USALink will take you outside the VA website.. AIDS Care. 2014;26(6):731-5.